Search

Factors predictive of chronic pain in older adults could help focus prevention and treatment efforts for those most at risk of chronic pain.The objective of the study was to describe demographic and pain self-management factors predictive of chronic pain in the context of opioid adverse drug events (ADEs) reported for a cohort of older adults within the same year.The design was a post hoc analysis of 9,095 cases aged 65 years and older from the 2019 National Health Interview Survey that reported chronic pain and 380 cases aged 65 years and older with opioid adverse events reported to the Food and Drug Administration Adverse Event Reporting System (FAERS) during the second quarter of 2019. Logistic regression predicted chronic pain.Less than a baccalaureate education increased the odds of chronic pain by 28.0% while lower income minimally increased the odds. Male gender increased the odds of chronic pain by 12.0%. Increased age minimally increased the odds for chronic pain. Use of opioids, other pain treatments, complementary treatments, and antidepressants were all associated with increased odds of chronic pain. FAERS opioid ADEs ranged from pruritus to death, with death identified in 16 (4.2%) cases. Misuse, abuse, or dependence was documented in 1.8% of cases.Less-educated older adults may be particularly at risk of chronic pain and should be routinely assessed and prescribed safe and efficacious pain self-management as needed. Some men may need additional support to use pain treatments.

The aim of the current randomized attention control pilot study was to conduct a preliminary test of a facilitated reminiscence intervention about past physical activity for the effect on increased physical activity and reduced pain in older adults with osteoarthritis. Thirteen older adults were randomized to the facilitated reminiscence or health education group and participated in six individual sessions over 6 weeks. Reminiscence functions, self-reported physical activity, pain intensity, and pain interference with function were measured at baseline and 1 and 3 months postintervention. Facilitated reminiscence did not result in increased physical activity, but instead resulted in increased pain intensity. Content analysis of reminiscence session transcripts indicated most reminiscence was conversational. Benefits from reminiscence included reconnecting with estranged family and distraction from pain. Past physical activities might be helpful to include as part of a program of facilitated integrated reminiscence for individuals with sufficient history of past physical activity. [Res Gerontol Nurs. 2019; 12(4):193–202.]

Cancer pain is one of the most common symptoms in cancer patients and often has a negative impact on patients' functional status and quality of life. Despite the available guidelines for effective pain management, factors such as barriers to cancer pain management still exist. The lens or philosophical assumptions used to guide cancer pain management research is a crucial but often overlooked component of high-quality research. Therefore, the purpose of this scoping review was to classify and map the available evidence and identify the knowledge gap regarding using a philosophical assumption to address the barriers of pain management among patients with cancer. Absence of clear philosophical assumptions in the qualitative research and generally a theoretical quantitative research may contribute to the slow progress in identifying and addressing barriers to cancer pain management. Therefore, the hermeneutic circle was suggested to address the main barriers of cancer pain management, focusing on the dialectic approach between the participants including researchers, cancer patients, and their family caregivers, health care providers, and policymakers. Understanding and possible solutions of the problem could be obtained through fusion of the horizons; in which the participants past and present horizons emerge. Then the collaborative efforts between the participants may yield effective strategies to overcome cancer pain barriers to improve the quality of cancer pain management.

Background: Older adults who take analgesics for chronic pain are at increased risk for adverse drug events (ADEs). Aims/Design: The purpose of this descriptive pilot survey was to examine how older adults self-identify analgesic ADEs, and actions they take in response to analgesic ADEs. Setting/Participants/Methods: Twenty-two community dwelling older adults with chronic pain who reported an analgesic ADE associated with their chronic pain management were interviewed and asked to describe their analgesic related ADE. Written responses were content analyzed. Results: Nineteen opioids were reported by 15, 11 NSAIDs were reported by 8, and acetaminophen was reported by 2 older adults as associated with an ADE. Gastrointestinal ADEs were most common with upset stomach (31.8%) most frequent. Neurological ADEs were also common but more varied with dizziness (27.3%) and headache (13.6%) reported most frequently. A total of 54.5% responded to their ADE by contacting their physician. Three (13.6%) went to the emergency department. A total of 36.4% stopped taking their ADE associated analgesic, 22.7% started taking a different analgesic, and 22.7% started prophylaxis. Three (13.6%) continued their ADE related analgesic. A total of 54.5% reported their symptoms subsided, but 13.6% reported their symptoms remained. Conclusions: A significant number of older adults with chronic pain self-manage their analgesic related ADE without contacting their primary care provider. Analgesic related ADE prevention and management should be discussed during primary care visits to reduce ADEs and enhance pain management outcomes for older adults with chronic pain.

Background Changes over time to self-managed chronic pain treatments are not a routine part of pain management discussions and might provide insight into adjustments that improve pain outcomes. Aims The purpose of this study was to develop and test an electronic pain management life history calendar (ePMLHC) for use with older adults with chronic pain. Design An instrument development design was used to develop and test the ePMLHC. Methods Twenty-four community-dwelling older adults with osteoarthritis pain completed the ePMLHC describing their pain treatment regimens and treatment response history. Accuracy of the ePMLHC data was examined through post-ePMLHC audiorecorded interviews, with the older adults describing their pain treatment history. Feedback on use of the ePMLHC was also measured. An iterative process was used to refine and retest the ePMLHC. The final ePMLHC version was examined with the remaining 12 older adults. Results Significant differences between data reported via the ePMLHC and interviews did not support feasibility of independently reported data via the ePMLHC. Older adults reported that completing the ePMLHC helped them more fully self-reflect on their pain self-management. Conclusions The ePMLHC has the potential to enhance communication about past pain management treatments and promote more personalized pain treatment regimens, but further development is required.

Background Effective acute pain management strategies are important for young adults in order to reduce risk for transition to chronic pain. Aim To describe pain and pain self-management strategies used by African American young adults. Design & Setting A national online cross-sectional survey design was used. Participant/Subjects Ninety-four African Americans Qualtrics panelists ages 18-25 who reported previous experience with acute pain responded. Methods: Respondents completed the Brief Pain Inventory Short Form to describe their pain intensity, pain interference with function, pain self-management, and percent of relief obtained from their self-management. Results African American young adults reported pain primarily in the back (n = 22, 23.4%) and head (n = 19, 20.2%), with moderate pain intensity M = 4.5 (standard deviation [SD] = 1.79) and pain interference with function M = 4.6 (SD = 2.36). African American young adults described their worst pain in the last 24 hours as M = 5.7 (SD = 2.01), least pain as M = 3.4 (SD = 2.41), and average pain as M = 5.1 (SD = 2.09). They reported 61.3% pain relief from self-treatment. A total of 45 (47.9%) reported no pain self-management strategies. Conclusions African American young adults report moderate levels of pain intensity and pain interference with function. A significant number report no pain self-management strategies. Focused pain assessment and education about efficacious pain self-management strategies, both pharmacological and complementary, could assist young African Americans to reduce their pain and risk of chronic pain in the future.

Pain management trajectory data that includes previous pain treatments, timing, changes, and outcomes provide crucial data for patients with chronic pain and their practitioners to use when discussing ways to optimize pain management regimens. The aim of this study was to test the use of the life history calendar method to identify pain treatments, treatment regimens, timing, and outcomes of the pain management trajectory of individuals with chronic pain, and to examine feasibility. A pilot, descriptive, methodological design was used. Settings included community-based sites such as congregate housing. Nineteen community-dwelling older adults with osteoarthritis (OA) pain of at least 1 year's duration participated. Participants were interviewed and asked to chronicle from the beginning of the OA pain to the present all of their pain treatments and treatment effects (pain outcomes and adverse events). Raters independently content analyzed the transcribed interviews to identify pain treatments, treatment groupings (regimens), and treatment effects on pain. Feasibility of patients reporting their pain management trajectories was content analyzed by identifying participant difficulty identifying pain treatments, treatment effects, treatment sequence; and difficulty discriminating between treatments, and between OA pain and other pain sources. Individual pain management trajectories were constructed that depicted chronological order of pain treatment regimens and treatment effects. Participants identified pain treatments, discriminate between treatments and between OA and other conditions, and identified treatment effects. Treatment sequence was identified, but more precise timing was generally not reported. Pain management trajectories could provide a helpful way for practitioners to discuss safe, efficacious pain management options with patients.

There is a need to enhance patient and practitioner pain communications. A pain communication plus virtual pain coach intervention was tested in the primary care setting for the effect on communication of osteoarthritis pain information by older adults aged ≥60 years, on practitioners’ pain management changes, and on older adults’ reduced pain and depressive symptoms 1 month later. A randomized controlled pilot study design was used. Twenty-three older adults with osteoarthritis pain were randomly assigned to the pain communication plus virtual pain coach group or the pain communication–only group. Pain communication consisted of a video of important osteoarthritis pain information. The coach consisted of practicing out loud with a virtual pain coach via laptop computer. Pain and depressive symptoms were measured with, respectively, the Brief Pain Inventory Short Form and the Beck Depression Inventory II before intervention and 1 month later. Immediately after the intervention, older adults had their primary care visits, which were audiotaped, transcribed, and content analyzed for older adults’ communicated pain information and practitioners’ pain management changes. Older adults in the pain communication plus virtual pain coach group described significantly more pain source information and were prescribed significantly more osteoarthritis pain treatments than older adults in the pain communication–only group. A nonsignificant trend in pain intensity and depressive symptoms reduction resulted for older adults in the pain communication plus virtual pain coach group 1 month later. The virtual pain coach presents a possible strategy for increasing pain management discussions between practitioners and older adults with persistent pain.

Objective. To pilot test the effects of a virtual pain coach on ambulatory Spanish-speaking older adults with pain from osteoarthritis. Methods. A randomized, controlled design was used. Eighteen Spanish-speaking older adults were randomly assigned to the virtual pain coach and pain communication education group, or to the pain communication education-only group. All participants viewed the pain communication videotape. Participants in the virtual pain coach group practiced talking about their osteoarthritis pain with the virtual pain coach. Immediately after the respective intervention, participants had their ambulatory medical visit. Pain intensity and pain interference with activities were measured with the Brief Pain Inventory, and depressive symptoms were measured with the Beck Depression Inventory II at baseline and 1 month later. Results. No significant group difference emerged for pain intensity, pain interference with activities, or depressive symptoms 1 month later. More older adults in the virtual pain coach group reported a change from nonuse to use of opioids at 1 month, 50% vs 0% of the education only group, Fisher's exact test, P = 0.023. Conclusions. Preliminary data indicate that the Spanish virtual pain coach might assist Spanish-speaking older adults to talk with their practitioner about their osteoarthritis pain and obtain opioid treatment changes, but that pain and depressive symptoms continue unchanged 1 month later. Additional refinement and testing is required for the Spanish-speaking virtual pain coach to determine acceptability and outcomes for assisting Spanish-speaking older adults to communicate about their pain with their primary care practitioner.

Purpose: To identify predictors of older adults’ use of exercise and/or acetaminophen, and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat their osteoarthritis pain. Data sources: Data were analyzed from 457 adults aged 60 and older with moderate or greater osteoarthritis pain intensity who responded to the Brief Pain Inventory between 2006 and 2007. The following predictors were entered into a logistic regression to predict use of exercise and/or acetaminophen and nonuse of NSAIDs: age, gender, ethnicity, race, education, arthritis treatment by a practitioner, pain treatment by a practitioner, pain intensity, functional interference from the pain, and percent of pain relief from current treatments. Conclusions: A total of 213 (46.6%) reported using exercise and/or acetaminophen and did not report using NSAIDs. Older adults reporting arthritis treatment by a practitioner were 2.2 (confidence interval 1.08–4.59) more likely to use recommended arthritis pain treatment, p < .03. Only 3–4% of the variance for use of recommended pain management treatment was explained by the predictors. Implications for practice: Results underscore the importance of guidance by practitioners who are knowledgeable about safe osteoarthritis pain management for older adults.

The purpose of this secondary analysis study was to identify factors associated with increased pain communication by older adults. Data were obtained from 312 older adults with osteoarthritis pain. Content analysis was conducted using criteria from the American Pain Society’s “Guidelines for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis” to identify important pain management information described by the older adults in response to general questions about their pain. Gender was the only factor associated with increased pain communication from the predictor variables of age, education, gender, ethnicity, race, marital status, pain intensity, functional pain interference, treatment from a practitioner for arthritis and for pain, and pain relief. The lack of association between pain communication and factors such as pain intensity suggests that practitioners should routinely elicit specific pain information from older adults who have a history of chronic painful conditions such as osteoarthritis.

The aim of this study was to examine the basic social psychological process of managing inadequately relieved pain in adults. Transcribed data from 23 ambulatory medical visits of adults with pain and interviews with four practitioners and four patients with pain were analyzed using constant comparative analysis. The basic problem was perception of running out of treatment options. Trialing was the process used to resolve the problem and consisted of four phases: finding the right practitioner, initiating the trial, adjusting treatments, and continuing to monitor with the patient taking control over the pain. Failure to achieve control over pain occurred when providers were unclear or failed to listen or when patients disagreed about treatment. Improving patient-provider communication may enhance trialing.

This descriptive study explored how patients communicate their pain and pain management needs after surgery. Thirty postoperative patients were interviewed. The majority described avoiding or delaying communicating their pain at some point during their hospitalization. Reasons for decreased pain communication included not wanting to complain; not wanting to take the provider away from other patients; avoiding unpleasant analgesic side effects; and not wanting to take “drugs.” Postoperative patients may be unclear about their role in pain management. Pain management communication problems identified in this study could be used to design intervention studies to improve pain communication and consequent pain relief. Copyright © 2000 by W.B. Saunders Company

Background: This study examined nurses' personal experiences with pain and whether nurses' personal pain experiences were associated with initial pain management knowledge and ability to learn more about pain management. Method: This descriptive correlational study was a secondary analysis of a study that used a one-group pretest-posttest design to examine the effect of a pain management education program on nurses' pain management knowledge. The sample consisted of 177 nurses who answered yes to having had a personal pain experience requiring treatment. Results: Nurses reported 13 types of pain, with pharmacological interventions comprising 94.4% of the pain treatments. Nurses' previous personal pain experiences were negatively related to their initial pain management knowledge (r = - .23, p < .01). Conclusion: Nurses' personal pain experience may impact their learning of pain management knowledge and should be considered when designing pain management education.

A quantitative descriptive secondary data analysis design was used to describe older black adult communication of osteoarthritis pain and the communication strategies used to convey the pain information. Pain content from 74 older black adults with persistent osteoarthritis pain was analyzed using criteria from the American Pain Society arthritis pain management guidelines that included type of pain (nociceptive/neuropathic), quality of pain, source, location, intensity, duration/time course, pain affect, effect on personal lifestyle, functional status, current pain treatments, use of recommended glucosamine sulfate, effectiveness of prescribed treatments, prescription analgesic side effects, weight management to ideal body weight, exercise regimen or physical therapy and/or occupational therapy, and indications for surgery. Communication strategies were analyzed with criteria derived from Communication Accommodation Theory that included being clear, using medical syntax, using ethnic specific syntax, being explicit, and staying on topic when discussing pain. The majority of communicated pain content included pain location, intensity, and timing. Regarding communication strategies, most of the older black adults used specific descriptions of pain and remained on topic. Fewer used explicit descriptions of pain that produced a vivid mental image, and few used medical terminology. Use of medical syntax and more explicit descriptions might improve communication about pain between health care practitioners and patients. Practitioners might assist older black adults with persistent osteoarthritis pain to communicate important clinical pain information by helping them to use relevant medical terminology and more explicit pain descriptions when discussing pain management.

To identify predictors of older adults' use of exercise and/or acetaminophen, and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat their osteoarthritis pain.Data were analyzed from 457 adults aged 60 and older with moderate or greater osteoarthritis pain intensity who responded to the Brief Pain Inventory between 2006 and 2007. The following predictors were entered into a logistic regression to predict use of exercise and/or acetaminophen and nonuse of NSAIDs: age, gender, ethnicity, race, education, arthritis treatment by a practitioner, pain treatment by a practitioner, pain intensity, functional interference from the pain, and percent of pain relief from current treatments.A total of 213 (46.6%) reported using exercise and/or acetaminophen and did not report using NSAIDs. Older adults reporting arthritis treatment by a practitioner were 2.2 (confidence interval 1.08-4.59) more likely to use recommended arthritis pain treatment, p.03. Only 3-4% of the variance for use of recommended pain management treatment was explained by the predictors.Results underscore the importance of guidance by practitioners who are knowledgeable about safe osteoarthritis pain management for older adults.

This paper reports on a study conducted to describe what traditional and non-traditional treatments older adults with osteoarthritis use for pain management, their reported pain relief, and factors associated with use of recommended initial gold standard treatment (acetaminophen/paracetamol or non-steroidal anti-inflammatory drugs, and exercise and/or physical therapy) as designated by conventional western medicine.Osteoarthritis is characterized by joint pain, stiffness and limited range of motion and has been designated an international health burden by the World Health Organization. Demographic and cultural factors have been shown to affect both traditional and non-traditional osteoarthritis treatment decisions.A descriptive correlational design was used, with secondary analysis of data collected between July 2006 and July 2007 in two randomized controlled studies using the Brief Pain Inventory Short Form and testing older adults' pain communication.The frequency of use of gold standard treatment was 28.0% (n = 128). Both traditional and non-traditional treatments were used by 46.4% (n = 212) of the participants. Logistic regression revealed that those with higher education (odds ratio 1.56, CI 1.24-1.96, P = 0.001), and non-White race, regardless of educational level (odds ratio 2.02, CI 1.20-3.40, P = 0.008), were more likely to use gold standard treatment.Factors influencing older adults' use of gold standard treatment for their osteoarthritis pain need to be identified so that greater numbers of older adults can be supported to use recommended treatment to obtain greater pain relief.

The aim of this study was to test how practitioners' pain communication affected the pain information provided by older adults. A post-test only, double-blind experiment was used to test how the phrasing of practitioners' pain questions-open-ended and without social desirability bias; closed-ended and without social desirability bias; or open-ended and with social desirability bias-affected the pain information provided by 312 community-living older adults with osteoarthritis pain. Older adults were randomly assigned to one of the three pain phrasing conditions to watch and orally respond to a computer-displayed videotape of a practitioner asking about their pain. All responded to a second videotape of the practitioner asking if there was anything further they wanted to communicate. Lastly, all responded to a third videotape asking if there was anything further they wanted to communicate about their pain. Transcripts of the audiotaped responses were content analyzed using 16 a priori criteria from national guidelines to identify important pain information for osteoarthritis pain management. Older adults described significantly more pain information in response to the open-ended question without social desirability. The two follow-up questions elicited significant additional information for all three groups, but did not compensate for the initial reduced pain information from the closed-ended and social desirability-biased groups. Initial use of an open-ended pain question without social desirability bias and use of follow-up questions significantly increase the amount of important pain information provided by older adults with osteoarthritis pain.

The purpose of this exploratory study was to describe Greek registered nurses' personal and professional pain experiences and to examine the relationship with their pain management knowledge. Forty-six Greek nurses provided written responses to open-ended questions about their personal and professional experiences with pain and beliefs about suffering. Reporting a personal pain experience was associated with describing a positive professional pain experience, Phi=0.44, p < 0.03. The nurses vividly described their personal and professional pain experiences. One nurse wrote " em leader I begged to lose consciousness, in order not to feel". These compelling accounts might motivate nurses to strengthen their understanding of pain management.

Thirty older adults, without chronic pain, were interviewed about the acute pain reduction strategies that they used at home and strategies that they might use if hospitalized. Verbatim transcripts from the audiotapes were content analyzed. Successful pain reduction strategies included taking a mild analgesic and positioning. If hospitalized, 16 (53.3%) would request analgesics; four (13.3%) would talk with a health care provider; five (16.7%) would continue their own pain reduction strategies; four (13.3%) provided no pain reduction strategies. Results suggest that many older adults possess pain reduction strategies that may be helpful to incorporate in their pain management when hospitalized.